Health and Race

Race interacts with health just as it does with other life determining, sociodemographic factors like class, gender, and age. Race is best understood as a shared set of cultural and social experiences common to people of the same skin color. Research has shown that the notion of distinct biological races is misleading because often more genetic variation exists within a defined “race” than between them. Therefore, we all belong to the human race and thus race is a social construction rather than a “true” bio logical distinction. Even though race is socially constructed (American Sociological Association 2002), the manner in which it influences social relationships suggests that race is a valid con struct with “real” repercussions.

Race, for example, is often associated with health, which the World Health Organization defines as a state of physical, mental, and social well being. The relationship is important. By knowing an individual’s race, that person’s health lifestyle and illness behavior can frequently be predicted. Race and health interact on several levels, as seen in the health effects of racism and discrimination, class differences in health status, access to health care, doctor-patient interaction, health culture, representation in medical professions, and the racial health disparities in the United States and abroad.

There are substantial differences in health status among people of color in America and worldwide. For example, the rate of Hepatitis B is higher among Asians. Hispanics have a higher incidence of certain cancers, such as cancer of the cervix and stomach. Native Americans have high rates of alcoholism and diabetes. African Americans have an average life expectancy that is 7 years less than that of whites. So clearly there are differences in the health status of whites and non whites.

One of the ways race influences health today is through racism and discrimination. All types of racism and discrimination contribute to this problem overtly, institutionally, and covertly. There are many overt ways in which racism affects health, such as through environmental racism, which is racial discrimination in environmental policy making, enforcement of laws, and regulations (Chavis 1993). This causes a disproportionately large number of health and environmental risks for people of color in the communities in which they live. These risks come in the form of housing placed near waste dumps, living in housing with lead based paint, exposure to pesticides, and neighborhoods located in areas with contaminated land, air, and water. Environmental racism has existed for generations like other forms of racism, and is maintained by redlining, zoning, and political decision making. Increased environmental exposure to pollutants in communities of color considerably elevates the risk of its inhabitants for a variety of diseases. Covert discrimination and racism in the medical system also influences health. Even when people of color have equal access and provision for health care services, they are less likely to be treated as aggressively as whites with procedures like chemotherapy and surgery (Jones 2000). Such treatment decisions ultimately exacerbate the health status of people of color by causing excess and premature mortality.

In order to understand the effects of racism and discrimination on health and how they influence health today, we must take into account its historical antecedents, using the concept of total discrimination. Historically, the institution of medicine was used as a basis of legitimization and justification for the oppression and disenfranchisement that non white “races” have experienced. For instance, medicine was used to justify the enslavement and subjugation of many people of color. Non whites were viewed as subhuman animals, less intelligent, and biologically inferior to whites. More specifically, medical knowledge like virology has been applied to instances of genocide of native peoples. Native Americans receiving smallpox infected blankets from Europeans is an example of these practices. In the same way, enslaved African Americans were used as human guinea pigs for medical procedures and treatments like abortion, hysterectomies, and amputation. Similarly, governments have sanctioned medical experiments on its minority citizens such as the Tuskegee Experiment (African Americans) and the South Dakota Hepatitis A Vaccine Study (Native Americans). Both of these experiments ended relatively recently, in the 1970s and 1991, respectively.

The policies of the past have translated into a pervasive distrust of the medical establishment. This distrust has influenced three outcomes:

an underutilization of formal medicine,

the utilization of formal medicine in concert with traditional cultural specific alternative means of healing, or

lack of participation in clinical trials.

Every racial and ethnic group has its own culture specific version of folk and faith healers; among Latinos, it is the Cuarandersmo/Cuarandersma; for African Americans, its root workers; for Asians, its acupuncturists and herbalists; for Native Americans, bone-setters. These healers use rudimentary health practices combined with aspects of religion and mysticism. Folk and faith healers are more effective in improving the patient’s mental and spiritual sense of well being than in improving physical health. Still, their contribution is not to be taken lightly given that mental well being is directly related to immune response. Furthermore, these healers offer a holistic (treating the body and mind as integrated units) approach to healing that most formal healers lack.

In the same way, the use of faith and folk healers is also due in part to the under representation of people of color in health professions. The paucity of people of color among health care professions is partly due to non whites formerly being prohibited and later discouraged from entering the health professions. This is important because when patients and professionals are of different backgrounds (races) there is a greater potential for racial stereotypes, prejudice, and lack of cultural sensitivity, as well as language barriers affecting the quality of medical encounters. Therefore, some people may decide if they cannot visit a health care professional with a similar racial background, they may avoid contact with formal medicine all together. Simply, many people of color feel more comfortable with health care providers and researchers of similar back grounds who have an understanding or appreciation of their culture.

The unwitting participation of minorities in medical experiments in which people died or were disabled severely hinders efforts to recruit and enroll people of color in present day clinical trials. Participation in clinical trials is critical to the development of cures, because clinical trials help determine if drugs are effective. Also, by participating in clinical trials participants receive new information about their disease. The under representation in clinical trials also limits the potential for drugs to be designed specifically for people of color.

Access to care is another important factor that must be considered in looking at race and health. People of color are disproportionately poor, unemployed, or employed in jobs that do not provide health insurance. Therefore, they are more likely to be without or have limited access to health care. The costs of office visits, medicines, and therapy are an onerous burden for impoverished people. Also, the location of health care facilities influences access to care when there is closure of hospitals that formerly served non white communities. Typically, non white neighborhoods often do not have adequate medical facilities located within a suitable distance and thus make health care inconvenient for many. Also, many people of color obtain their health care through the public system of health care rather than the private system. The public system may feature long waiting periods, lack of adequate staff, and limited resources. Thus, it may not be able to provide the necessary treatment options that can impact the quality of care people of color receive. Due to the distrust of medicine, being on the receiving end of poor doctor-patient interaction, and the high cost associated with seeing a health professional, many people of color probably do not seek preventive care, such as routine physicals and screenings. Consequently, they may delay seeing a professional until their disease is in a critical or life threatening stage.

Racism also affects health on a more personal level. A term for experiencing racism is ”personally mediated racism.” Personally mediated racism is defined as ”prejudice and discrimination, where prejudice means differential assumptions about the abilities, motives, and intentions of others according to their race” (Jones 2000: 1214). Personally mediated racism manifests itself in day to day interactions through devaluation, suspicion, and dehumanization of people of color. Despite a greater utilization of a social support network, racism is a powerful stressor which takes a psychological and physiological toll over time. Psychologically, racism may lead to feelings of helplessness, anxiety, frustration, and nihilism (Clark et al. 1999). Physiologically, stressors like racism negatively impact cardiovascular, immune, and endocrine systems, thus leaving people of color particularly susceptible to a variety of ailments.

Besides racism, racial differences in health also result from patterns of health care utilization, genetics, and health culture. First, differences in health among races may be due to a greater reluctance of non whites to use formal medicine for the reasons specified earlier. Genetics apparently plays some role, in that certain racial groups are predisposed to certain conditions, such as sickle cell anemia among African Americans and significantly higher rates of diabetes among Native Americans.

Health culture among different ”races” may also explain differences. As mentioned earlier, people of color are more likely to utilize folk and faith healers from their own culture in concert with traditional medicine. Also, they are more likely to use a lay referral network, which is the process by which an individual consults lay people such as friends and family members to guide them in interpreting symptoms, deciding whether care is needed, and the type of care they should seek. This process may delay the seeking of professional help. In the same way, different racial groups have innate cultural means of promoting health. Some of these are the stress buffering properties of the extended family network (social support); diet (nutrition); alternative healing practices (e.g., acupuncture); and subcultural emphasis on physical and mental health (e.g., yoga). In contrast, there are aspects of culture that are detrimental to health, such as lack of oral hygiene, internalization of stressors, and lack of disclosure of health status of family, friends, and sometimes the patients themselves.

Recently, racial health disparities between races have begun to receive greater attention in the US and worldwide. In the US efforts are being made to better understand the causes of health disparities. Some areas being examined are access to care and the effects of racism, genetics, diet, and health culture. Internationally, the WHO has been examining many of these issues, such as diseases that disproportionately affect people of color, such as HIV, TB, cholera, substance abuse, and a host of chronic diseases like cardiovascular disease, cancer, and mental illness.

There are methodological issues to be considered when examining the relationship between health and race. First, since race is a social construct, it is not measured consistently across societies. For example, racial categories in health data in America are not standardized. Second, in some situations, ”race is not an attribute, but a dynamic characteristic dependent on other social circumstances” (Zuberi 2000: 172). So race is a construct that is defined differently and varies by country. For instance, in Brazil ”races” are organized not only by skin color, but by hair type and language. Third, there is the problem of categorizing races. For instance, in some parts of the US, health data are only divided into white and non white categories. This practice is problematic because researchers are unable to uncover key differences and report on the health of Hispanics, Asians, Native Americans, and African Americans. A standardization of racial categories across the world is needed, though creating a racial taxonomy would be difficult and perhaps cause misunderstanding.

As citizens of the world immigrate and migrate we will see greater diversity in societies as non white populations increase. Thus, all developing and developed nations will have to grapple sooner or later with the issues raised here.

References:

American Sociological Association (2002) Statement of the American Sociological Association on the Importance of Collecting Data and Doing Social Scientific Research on Race. Chavis, B. F., Jr. (1993) Confronting Environmental Racism: Voices from the Grassroots. South End Press, Boston.